Purpose :
The aim of this study was to investigate the influence of four different distracting elements on surgical performance in a validated training program in vitreoretinal virtural reality surgery using the Eyesi Surgical Simulator software version 2.9.2 (VRmagic GmbH, Mannheim, Germany).

Methods :
We used a validated training program of Navigation level 2 (Nav2), Bimanual Training level 3 (BimT3), Posterior Hyaloid level 3 (PostH3) and Internal Limiting Membrane Peeling level 3 (ILMP3). The program was tested on five medical students who had trained until they achieved the same target score as an experienced vitreoretinal surgeon in each training module (Nav2=65.2 points (p), BimT3=77.6 p, PostH3=55.8 p and ILMP3=72.8 p).The subjects conducted the training program under the influence of the following operational challenges:- Virtual eye surgery with auditory distraction (AD) (one difficult question/task they had to answer during each module).- Virtual eye surgery after being woken during night-time sleep (NTS).- Virtual eye surgery after 12 hours of fasting for solid food (FAS).- Virtual eye surgery after 24 hours of sleep deprivation (SD).Points and time used to complete the different tasks were noted. The scores in each module were assessed from 2-5 different factors (i.e. Target Achievement, Efficiency, and Tissue Treatment).

Results :
For the following modules, a statistically significant decrease in score was observed after the introduction of the four distractions: PostH3 during AD (71 vs. 51, p<0.05), and for overall score during AD (344 vs. 286, p<0.05), and NTS (344 vs. 264, p<0.05).For the following modules, a statistically significant increase in time used was observed after the introduction of the four distractions: PostH3 during FAS (5.21 min vs. 6.65 min, p<0.05) and for overall time during FAS (9.24 min vs. 11.71 min, p<0.05).

Conclusions :
Surgical performance was affected by auditory distraction in overall score and PostH3 score. Furthermore, it was found that more time was used overall and in PostH3 when subjects where fasting. Overall, there was a trend that distractions during virtual VR surgery negatively affected the surgical performance.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.